A&A practice
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We present the case of a 55-year-old woman undergoing a delayed latissimus dorsi flap breast reconstruction after a simple mastectomy for breast cancer. Preoperatively, 2 unilateral paravertebral catheters were placed at T3/4 and T7/8 for postoperative analgesia. ⋯ The patient had excellent postoperative analgesia and required no opioids or other analgesics through postoperative day 10. We report that multilevel paravertebral nerve blockade could represent an opioid-sparing alternative for postoperative analgesia for latissimus dorsi flap breast reconstruction patients.
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We present a 36-year-old female patient who underwent transradial cerebrovascular angiography because of acute putaminal hemorrhage. Catheter entrapment occurred with severe pain in the right upper arm proximal to the elbow. ⋯ An ultrasound-guided supraclavicular brachial plexus block relieved both within 3 minutes. In the past, general anesthesia would have been administered.
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Patients with severe pulmonary hypertension (PHT) represent a high-risk population when undergoing noncardiac surgery. During thoracic surgery with 1-lung ventilation, atelectasis of the operative lung, and frequently associated hypoxemia, is likely to exacerbate PHT and precipitate acute right ventricular failure. ⋯ After successful resuscitation in the operating room, she subsequently required prolonged venoarterial extracorporeal membrane oxygenation. Focused transthoracic echocardiography to evaluate cardiac function was critical in the diagnosis of PHT and subsequent treatment with sildenafil and nifedipine when discharged from the hospital.